I use a beta blocker for problems unrelated to musical performance, and find that it eliminates stage fright, which I sometimes have, which has been strong enough to interfere with performance. On the other hand, Using it definitely changes my performance, and I lose a little edge. I sometimes skip the pill on the morning of a performance.

I use them for auditions and difficult concerts, so I use them several times a year at most. I would never use them for every performance and actually rarely at my job with the 1st Infantry Division Band. It's a tool I use for particularly stressful events. I tend to feel shaky, a result of nervous tension and they alleviate this. It's easier said than done to relax in these situations. One of my past teacher's uses them, but infrequently, for maybe 9 or 10 works in the orchestral repertoire that he finds very stressful. I tried them as a result of his recommendation. I do think that the excitement produced by having a live audience adds something to the performance, maybe some inspiration to be spontaneous? I find that the pill significantly reduces or eliminates this excitement, and I feel that my playing is a little lackluster as a result, hence my minimal use of them.
Christopher Nichols
1st Infantry Division Band

I too take a rather large dose of an extended release beta blocker and have noted the absense of stage fright, which I also attribute to the drug, although this old dog has learned to control his nerves somewhat in 60 years. I not preaching, and it's really none of my business, but I think that skipping a dose of a beta blocker is not recommended-well at least abruptly stopping it isn't. Perhaps if you aren't on an beta-XL, asking the Dr. to switch you to one might help. Nevertheless, I don't percive any effect on my playing the BC, CA, or CB, although I'm only an amature in a community band who has dearly loved playing for 50 years.

When we feed our kids Prozac, Ritalin and the like I am not really surprised to hear that. Somehow it sounds odd to me that we have to gulp chemicals in order to perform what we love. I wonder what we take in order to do something we hate.

I would get debilitating nervousness and stage fright. It was so bad when I was in school that my instructors would comment on it. They couldn't believe the difference in my playing between a coaching or lesson and a performance. I found it to be a self fulfilling nightmare. I was fine when I was practicing or in an environment where I was at ease but in the back of my mind was always the specter of the looming performance or audition.

I started taking beta blockers when I was in grad school and it opened up a whole new world for me. It was amazing to me to be able to play at 90-95% of my potential at an audition, master class, or performance instead of what I had been accustomed to.

I never felt that they "took the edge" off of a performance like other posters have commented on. I felt they gave me back the ability to think and react accordingly in the middle of high stress, make or break situations.

I also use beta blockers for auditions and a very few difficult concert performances. After 5 years of annual auditions for the orchestra I play in and getting only a one-year contract each time due to nerves, I went to my doctor. As I described what was happening, he jumped in and suggested beta blockers right off. I am now a regular member of the orchestra and (Hooray!) I don't have to audition next fall. I take small doses and have not had trouble with being able to play and concentrate. To be honest, I am not much of a pill person and really hesitated to take this step. With the assurance of my doctor I went ahead and it has made a noticable difference. Don't do this without seeing a doctor.

After years of resisting them, I began using beta blockers last year. The thing that finally pushed me over the edge was a squeak in performance that occured right before a section I was worried about. I knew immediately that the only reason it happened was because I was so concerned with making a mistake. This forced me to consider my nerves in general, and I realized that often I was more worried about making a mistake than enjoying performing.

Furthermore, I began to question why it was that I made so many "stupid mistakes" in performance. Even when I wasn't uncontrolably nervous, I had a tendency to allow inconsistencies and uncharacteristic mistakes into my playing.

I began using beta blockers sparingly, and I am happy to say that my consistency as a performer has improved tremendously. I no longer am so concerned with playing correctly that I don't enjoy the moment. The level of playing has really improved, and I've enjoyed success (relatively speaking) in performances and auditions. I now feel as if I may be at the point that I don't need them.

To me, the main difference is not that they have eliminated nervousness. I'm always nervous for performances. But they have allowed me to focus more and bring me closer to a state of playing that is comparable to the practice room or for a very comfortable audience. For me, this is the ideal balance that I seek.

you aren't just calming your nerves but taking these, you are changing the way your nerves work. as you may or may not know, nerves are not connected. two join by means of nuerotransmitter, molecules that carry impulses from one nerve to the other. beta blockers inhibit this reaction, quote un quote making it harder for singnals from outside (an audition room, judges...) to reach the bain. normally, adrenaline would be present, which in turn directs most of your blood to your organs, away from you fingers, causing them to shake or become cold. your heart beats faster because, to your body, you are facing a dangerous predator.

just as the article said, it is unhealthy just like any other drug that changes how your body works.

the key is to train your body. you have to realize that you are there, at the auditon or what have you, because you love music. i dont know about you, but yeah sure it is scary to go in there. but the moment i play my first note, it all goes away. you must completely immerse yourself in the moment, as you must in every situation in life

in conclusion, i completely disagree with using them. the body is an amazing thing, tampering with it just to give you an "edge" is just as excuse for laziness.

"in conclusion, i completely disagree with using them. the body is an amazing thing, tampering with it just to give you an "edge" is just as excuse for laziness."

I think the hundreds of successful musicians in orchestras who you otherwise admire would disagree with that. My guess is that you have no idea how much time and effort they have devoted to their profession.

I also think the professionals on this board would be insulted by your simple remedies and ideas on how to combat nerves. Do you really believe for a second that they did not make serious attempts to fight their nerves naturally?

For the record, none of this has anything to do with gaining an "edge." For some, audition and performance pressures are worse than others. This is a means to compensate, not something that allows them to play better. The steroids analogy is a terrible one because steroids allow athletes to reach physical levels and abilities that would be otherwise unatainable.

Furthermore, please don't lecture this board on what you perceive as a health risk. Your six sentences about the function of nerves was very impressive, but the only thing you could accomplish with it was to determine that beta blockers change how your body works. Everyone knows this. Your analysis of "it is unhealthy just like any other drug that changes how your body works," is completely unnecessary. Since the data cited in the article is almost 20 years old (fine timing, by the way), I'm left to wonder why the author neglected to cite an example of a musician who used them for pressure situations and suffered "unhealthy" effects. I am, of course, excluding the obscure story about the pianist who not only obtained his medication illegally, but also took more than was recommended on first usage. There may be some example out there, but I'd like to see it before you make a very general statement about what the body can take.

Maybe a little more than a gut reaction and subsequent justification of this position is needed here?

however, is it not what your gut says is what you should always go by?

indeed, you have no idea how much i know and respect musicians in this world. yes, i know that nerves are worse with some people that others, but does that not change what i feel about it? no! all i had to say was i disagreed with it, and ranting about the nervous system was just me "studying" for my ap bio test next week. yes, i am a senior in high school. no, you have no right to tell me what i should and should not say on this board. i went with my gut, i vomited words and sentences as they were coming to me. there was no reason to get offended, or try to prove me wrong, or anything

every single time i try to post my feelings on here i somehow get bashed/corrected/some other dysplay of ego and superiority.

back to what my post was supposed to mean, i disagree with the drugs because of what it does to your body. thats it.

Frankly, since my name is mentioned at the top of this thread, I don't give much of a hoot who agrees with me or doesn't or who feels warm and fuzzy to whom.

There's just so much looking inside oneself to see into the heart of one's neighbor, so much attempt to universalize one's own experience. It's ridiculous for people to care so much about making someone else agree with them.

Yet it's easy to see why people get so aggressively defensive. Occasionally it may be an enjoyment of stirring up trouble. But most of the time it's because someone else has said, in effect, "No, you don't know how your life works, I know how your life works, so ditch that idea and listen to me instead."

If we give no one credit here for anything else, let's at least give everyone credit for knowing more about themselves than the rest of us do.

I completely agree with Greg's advice. As a former clarinetist, turned neurologist I can say that the beta blockers (e.g. propranolol, etc.)are very helpful and can actually help you "de-learn" the fear response (tachycardia, sweating, dry mouth, etc.). While I never used them while playing clarint, I found them very helpful with overcoming anxiety associated with giving talks. Don't let anyone suggest that their use to help you deal with the fear response is any sort of cop-out. It isn't. We differ in our physiological responses to fearful situations. Some of us are more like Jack Russell terriers, while others are more like a Labrador retriever. Beta blockers can be contraindicated in asthmatics. If this is the case be sure to mention it to your doctor. Otherwise they're pretty safe and would not be expected to have side effects at the occassional low dose needed to deal with stage fright. Good luck! Phillip

"however, is it not what your gut says is what you should always go by?"

No, absolutely not. And especially not when you're offering opinions on what others should do.

"yes, i know that nerves are worse with some people that others, but does that not change what i feel about it? no!"

That's fine, but don't minimize the experiences of others as laziness.

"there was no reason to get offended, or try to prove me wrong, or anything"

Yes there was. If information goes unchallenged on this forum or any other, it might actually be accepted by some.

"i disagree with the drugs because of what it does to your body. thats it."

This is immaterial because you haven't established what that is.

"every single time i try to post my feelings on here i somehow get bashed/corrected/some other dysplay of ego and superiority."

I can sympathize with this, only because someone your age should be encouraged to speak out and not immediately beat down. However, you have to be careful of both what you're saying and how you say it. I would not have challenged what you said if I felt it was a legitimate point. I also would not have challenged it if you hadn't refered to using beta blockers as laziness.

I love how open this forum is, but I am getting tired of people supplying false information on here, from mouthpieces to beta blockers. I realize that's inevitable if we want to keep this open. God knows I don't know everything and make mistakes myself. But people use the search engines for these archived threads, and this seems like the most logical way to handle it.

I am certain that my days as a professional musician were made worse by stage fright. I participated in a study at Stanford of pros w/stage fright. It included members of the SF ballet pit, SF symphony, Oakland symphony and a few soloists. I got the placebo, as the test was not for beta blockers. We got some meditation training which was not extremely helpful.

I went on Beta Blockers for performance for a few years and then stopped using them. I found I had unlearned the fear response, the meditation and other techinques were not that useful.

They do have some down side, I recall having terrible depression after one performance because I'd played a single wrong note (without missing a beat or anything.)

J.J. wrote: The steroids analogy is a terrible one because steroids allow athletes to reach physical levels and abilities that would be otherwise unatainable.

I disagree - you gulp something in order to be able to do something you wouldn't without. I am not saying this is good or evil, it's everyone's individual decision. But don't cheat yourself saying "this ain't no doping".
FWIW I might (or might not) take them in a pinch, I'm not saying I'm a saint.

I just think that taking pharmaceuticals for performance reasons sets a bad example. I know that a lot of the students on the uni here take BBs and whatnot before exams, and I know that they're used in the lower school grades too.

If we can satisfactorily function only while on drugs, what society is this?

I'm curious as to whether anyone on this board has any experience or knowledge of alternate ways of dealing with this type of nervousness. By this I mean something more than deep breathing and the standard mental exercises--some type of yoga or Eastern meditation, perhaps.

Markael,
does AT (autogenous training) belong to the standard mental exercises? I have been quite successful with it. Helped me to fight stage fright (having a speech in front of a big audience without a lectern to hide behind).

> Markael,
> does AT (autogenous training) belong to the standard mental
> exercises? I have been quite successful with it. Helped me to
> fight stage fright (having a speech in front of a big audience
> without a lectern to hide behind).
>
> My dentist uses hypnosis when treating patients that cannot
> stand narcotics.
>
> In the last years I developped fear of height, going beyond the
> rational caution. I'll see if I can fight it with AT and
> self-hypnosis.
>

>
> Post Edited (2006-03-25 11:45)

As I posted above, I received training at Stanford in mediatation and similar techniques and happened to be in the placebo group. I also tried hypnosis. Neither enabled me to unlearn the stage fright response. After a few years of using beta blockers I had unlearned the response. Your experience may be different.

One of my pet peeves is having kids perform pieces that are beyond their current level, I suspect this is where the fright response is learned.

> Ginny wrote: After a few years of using beta blockers I had
> unlearned the response.
>
> After a few years? How long did you try alternatives
> before reverting to BBs?
>

I had been playing for money for something over ten years when I got the beta blockers. I spent a fair amount of time and money on the alternatives and they simply did not work adequately. That is why I was accepted into the Stanford stage fright study along with a number of other pro musicians. However, it took beta blockers to unlearn the response. The difference was absolutely clearcut.

I am convinced that my marginal professional career was very much inhibited by stage fright. I wish I'd tried them first frankly.

This is a great thread. I have one of the worst cases of stage fright I know. I have it almost all the time not just in concerts or exams, and not only when I'm plaing clarinet. I think it is an extreme case since I can actually have it when I'm alone by just imagining a scary scenario.
Stage fright is part of the reason why I stopped playing classical music, and although if I could stop the stage fright I wouldn't return to playing classical music again, I would still want to stop it or reduce it as much as possible.
I've tried a few differnt natural pills (that you don't need a doctor perscription to get) and some liquid, and also a device called Mastermind, and none of it help.
I will definitely look into the beta blockers.

"The steroids analogy is a terrible one because steroids allow athletes to reach physical levels and abilities that would be otherwise unatainable."

"I disagree - you gulp something in order to be able to do something you wouldn't without. I am not saying this is good or evil, it's everyone's individual decision. But don't cheat yourself saying "this ain't no doping"."

I have to agree with the first statement. The pills will only help you deal with psychological problems in a certain scenario, and not improve your playing. Steroids will improve the athlete's ability.
But not only that. Sport competitions are just that - competitions. The purpose of music is not competition, but to make the listener hear the best music possible.

The debate over whether or not it is appropriate to use beta-blockers is not as interesting to me as the large number of professional musicians using it.

25% of players using and 70% of them getting them illegally is IMHO a concern. I should state that I am not a medical doctor and will never experience life as a professional musician. So everything I say pretty much amounts to nothing. However, if indeed 1 out 4 players are using drugs for stage fright, either some are abusing it or the stress level of professional performance is simply not healthy and a serious change in attitude towards classical music performance needs to be addressed.

The related links to opinions given by MDs and pro players are enlightening and I do believe that there is a point when pills are what you need. I have witnessed friends incontrollably shaking for a masteclass or performance and nobody should have to go through that. But do 25% of all musicians *really* need it? Why are so many gaining access to it illegaly?

The article from ubc.ca brushed over a lot of the details so it is hard to judge wether the musicians use it always or on occasion to break a cycle of bad stage fright. I would very interested if some research lab out there would run a study of using beta blockers vs. placebo. Do most performers on beta blockers actually need the chemical or is it a placebo effect?

There has always been a stigma around medicine for the mind. There is such a thing as chemical imbalance which can affect the mind in many different ways. Ask any teenager (or parent of) and his/her raging hormones. There is no reason why drugs should not be used to help correct this imbalance. Afterall, like it or not 100% of the people I know are hooked on caffeine.

Beyond the question of whether or not beta blockers are needed, one has to question the current state of classical music if a quarter of its contributors must be on drugs in order to simply do their job.

The analogy to professional athlete is IMHO ludicruous. Music is not professional sport, we are not talking about *enhancing* one's abilities, but simply bringing stress levels under control in order to show one's *true* abilities.

Music is not professional sport, we are not talking about *enhancing* one's abilities, but simply bringing stress levels under control in order to show one's *true* abilities.
What about auditions where half the competitors are doped and the other one aren't? Do you consider that fair?

From my personal experience I will relate one side effect which you may want to consider.

I was on beta blockers for a medical condition for a bit over a year; I also take a few other medicines for related conditions.

I noticed over time that I easily lost focus on the tasks Iwas supposed to be doing at work - my workmates & boss didn't really notice, but I knew things weren't quite right.

I finally talked to my doctor and I went off the beta blocker to see if that was the problem; it is a known effect.

It might be psychological (I'll never know for sure), but after a week or so I noticed (as did my co-workers) that I was more focused and intense at work. I've been off that particular medicine now for 2 years.

Nothing in what I read about beta blockers mentions enhancement of motor skills and/or musical knowledge. On the contrary, what I read is that the motor skills might be slightly impaired by beta blockers and that the relaxed state may take some excitment out of a performance.

We are talking about 25% of symphony players using the drug, how did the other 75% get their job?

I'll concede to you that there is no performance enhancing drug policy for classical musicians. Maybe the next Tchaikovski competition should start to drug test, I don't know.

I've found my calm on stage through ideological realizations, and a change of personal philosophy. Not food, not drugs, not imagining people in their underwear, not breathing, not meditation.

After thinking long and hard about the state of classical music today, and how I experience concerts as an audience member, I realized that what bothers me the most as a listener is a performer who lets errors throw them off, who gets upset at a lack of technical precision, and who has other concerns that trump the musicmaking experience. Technical imprecision, to me, is a secondary concern.

Yes, a performance with screwy missed notes will bother me. I'm a musician. But what bothers me more is seeing a performer beat themselves up and degrade the rest of their performance over said missed notes.

Once I came to peace with that, I (almost overnight) no longer had any problems performing in front of people. Only when I start thinking "it's important that I play this perfect" or "this is a really important performance. I'll show those audience members I have some chops!" rather than "hey, let's play some music" do my nerves return.

As I mentioned before I think the root cause may be having children perform pieces that are past their level in public.

Neither of my children gets stage fright happily. I made sure they were very well prepped prior to performances and playing pieces that they could handle with ease and grace. Occasionally the piano teacher had other ideas, but I made sure things came to level. My younger son is now a clarinet performance major, although this was not his first choice, he was not accepted in composition. He realises that although he can perform under very stressful circumstances as a soloist he does not enjoy it at all and would not want to do it for a living. He will be able to get the classes in theory and such that he wants anyway. He is also studying for a math degree.

Clarnibass wrote: It is fair. As far as I understand the medicine helps with the psychological problem of the scenario, and doesn't make the player play any better than he would have without it.

So the technical aspects are the only that count? If I have to evaluate a candidate I'd be very interested to see how she/he deals with stress, how he gets over a mistake (will he stop and curse, will he just continue as if nothing happened), and I'd very much like to see the usual, sober behaviour.

Perhaps musical auditions are different from candidate evaluations for eg a marketing job.

Natural herbal extracts *are* drugs. Living alcohol, smoke and caffeine free is good advice no matter what your job is. Learning how to manage stress and avoiding stressful situation when one can, is another pretty good way of life.

On the other hand, if we assume that not all classical musician are neurotic, then looking at the numbers presented in the article; the amount of stress brought by classical music is clearly unhealthy. My question is: can we do something about it as a community, or is it the individual who must learn to cope with it?

I believe a little bit of both. Talking to the audience, relaxing rules and protocols (e.g. when to applaud!) would make the experience more enjoyable for both audience and performers. Recognizing when stress is coming and learning how to deal with it is another aspect that should be incorporated in the teaching curriculum along with practising scales.

Anybody remember this quote from Tom Cruise? He was defending his criticism Brooke Shields' use of drug therapy for post-natal depression. Tom is a calm, focused, uber-wise guy...right? But what about discarding wives everytime they get crows feet, and jumping up and down on Oprah's couch over Katie Holmes? This makes me question the effectiveness of his holistic approach to say the least.

There seem to be two basic issues here. First is the idea of using drugs to either enhance your performance or overcome a disablility. I think that the deal with stage fright is the latter. We have PLENTY of orchestral clarinet candidates with near-perfect abilties and resumes. We could reject plenty of them over eyesight. After all, you could forget and leave your glasses at home. I don't have a tremendous problem with stage fright, but I do have a dread of making phone calls. If I have a problem with something this easy, then I have to sympathize with musicians who have to cope with trying to be superlative in an orchestral or recital environment. Stage fright is treatable, so it seems to me that using BB's, TM, fish oil, or whatever is a way of levelling the playing field, not tilting it.

The second is the idea that depending on drugs is bad for you. No argument here. Drugs produce all sorts of side effects but it doesn't seem to be hurting sales of Viagra. Those who take the drug feel that its benefits are worth the side effects. Classical musicians are stuck with exactly what's written on the page, and exactly how the conductor waves his stick. They have to play it right, and play it like they mean it--and with little or no wriggle room to accomodate their individual traits. If their daily practice and years of experience aren't enough to overcome stage fright, I'd say that they've ALREADY exhausted the natural solution (practice/experience) that work the best for most folks. Maybe it's worth it to them to take BB's in order to do what they love. Perhaps what we're leaving out of the discussion is the idea of weaning ourselves from the drugs once we experience their effects and our minds clear.

This thinking will not survive the logical extremes, but I'm not proposing that we hire paraplegic firefighters. As with that profession, music does not make accommodations possible for many handicaps. Nervousness is one handicap that can be addressed, so let's open the door at least THAT far.

And you never know what you'll find...can you imagine a one-legged paramedic working in the field? We had one in Richmond about 20 years ago. An exception had to be made in his licensing, but using crutches, he worked for years as a commercial ambulance attendant. I saw him lift his end of the stretcher many a time while not losing track of his crutches. The job was not changed for him...HE rose to the task.

An interesting side issue has been Ginny's contention that the fear response is induced by pushing students too hard on difficulty levels. I disagree that this is the source of the nervousness, I think that it's part and parcel of what we've developed classical music performance into. But I do agree with her that some folks push those kids just a little too far about what they're going to perform in public.

Okay, I've been reading this thread hoping somebody would ask this question so I wouldn't have to, but it hasn't happened. Somebody earlier mentioned "propranolol", etc. as BB's. I do not know exactly which drugs you are classifying as BB's. Could you please help me out? If these are prescription medications, such as Mark's for a medical condition, what doctor would prescribe them for performance anxiety? Mine certainly wouldn't. I guess I'm out of the loop on this. thanks for info.
Sue

"On the other hand, if we assume the not all classical musician are neurotic,"

You're silly. We all know there are two kinds of classical musicians... those who are neurotic, and those who are in denial about being neurotic.

-----

tictactux wrote:

"If I have to evaluate a candidate I'd be very interested to see how she/he deals with stress, how he gets over a mistake (will he stop and curse, will he just continue as if nothing happened), and I'd very much like to see the usual, sober behaviour."

I think you're on to something. If I were the one holding auditions, I'd have a person hide behind the auditioner to provide a distraction. Blow a loud horn behind them, make farting noises, provide a consistent A=435, etc. It would help to find out about the actual person, not just their ingrained standard repertoire chops.

-----

allencole wrote:

"If their daily practice and years of experience aren't enough to overcome stage fright, I'd say that they've ALREADY exhausted the natural solution (practice/experience) that work the best for most folks."

Those are only the brute force variety of non-chemical/dietary methods. Getting off our "I'll show THEM how I can play this!!!" high horse and playing for the music itself can do wonders. Tell yourself "I'm not nervous" until you're blue in the face, but as long as you're telling yourself that you're confident, there's some part of you saying "as opposed to what?" All the while, this dialogue is horribly distracting from the process of making the music.

Okay, I've been reading this thread hoping somebody would ask this question so I wouldn't have to, but it hasn't happened. Somebody earlier mentioned "propranolol", etc. as BB's. I do not know exactly which drugs you are classifying as BB's. Could you please help me out? If these are prescription medications, such as Mark's for a medical condition, what doctor would prescribe them for performance anxiety? Mine certainly wouldn't. I guess I'm out of the loop on this. thanks for info.
Sue

They are propranolol which is a beta blocker. I discussed my situation with my internist who prescribed and that I only take for performance as needed. I also discussed it with the researcher (a medical doctor) at Stanford.

Valerian root, available at health food stores, apparently has some beta-blocking effect, as well as putting you to sleep. See http://www.woodwind.org/clarinet/Study/Valerian.html However, I would be **VERY** reluctant to try it. Desipte the advertising, health food products that come from plants vary tremendously in potency depending on the particular plant they're extracted from.

If your physician is reluctant to prescribe a beta blocker, and you suffer from severe stage fright, ask him or her to refer you to another physician who treats musicians and will know how to evaluate your problem and find the right medication and dose. There are lots of highly ethical physicians who prescribe beta blockers for musicians who need them.

I haven't run into a doctor that was unwilling to prescribe beta-blockers for performance anxiety. I discussed the situation with each of them, explaining what I've used them for and why, and there's never been a problem.
Christopher Nichols
1st Infantry Division Band

I just reread the thread, did the study you participated in got published. I would love to know more about the topic.

I have never tried beta blockers an haven't had the need for them so I cannot report on their effect on me. However, I am interested in reading more about the frightening necessity of so many musician having to use them. Anybody knows of a scientific study on this particular topic?

I'm with ya, Botch. I'm sure that Tom comes by his quirks as honestly as the next guy. Just illustrating that in criticizing drugs as a therapy, he fails to present a viable alternative in his own example. Didn't know about Fire Island and Judy Garland, but it does sound like two strikes in many a ballpark.

Personally, I think that there's too much medication out there and it's a big problem. Ritalyn is a far more major issue than the one in this thread, in fact.

My main concern with this particular issue is that the enormous skill levels of the average orchestral clarinetist should be highly therapeutic in and of themselves in overcoming stage fright. Where those have failed, I am prone to cut those who seek other therapies a good bit of slack.

There is a lot of genius out there with some kind of mental handicap or another, and so many of these would completely preclude a career performing music. I just hate to discard anyone who can actually make it work.

This looks very interesting, although a single study can be wrong rather easily.

"Researchers from Imperial College London and Charing Cross Hospital have discovered a way to help musicians improve their musical performances by an average of up to 17 per cent, equivalent to an improvement of one grade or class of honours.

The research published in this months edition of Neuroreport, shows that using a process known as neurofeedback, students at London's Royal College of Music were able to improve their performance across a number of areas including their musical understanding and imagination, and their communication with the audience. "

OK, I just read a few articles here one particularly interesting:
Pearson RM, Simpson AF
Effect of oxprenolol in stage fright in musicians.
Trans Med Soc Lond. 1978-79;95:46-53
I have some library privileges but you might be able to dowload a pdf at:
http://www.psychosomaticmedicine.org/cgi/reprint/44/5/461

I have to give tictactux an apology. From what I read, it is becoming clear that using beta blockers *can* improve one's performance. It then seems a little unfair in competitions/audition to have some use them and others not.

Using them in a non competitive context is, however, a whole different story.

Without seeing how the double blind study was done to select who would participate one might only conclude that for people with this disability it levels the playing field. What % of the subjects took the BB and did not have stage fright? was their performance improved? It might well have been worse.Sylvain wrote:

> OK, I just read a few articles here one particularly
> interesting:
> Pearson RM, Simpson AF
> Effect of oxprenolol in stage fright in musicians.
> Trans Med Soc Lond. 1978-79;95:46-53
> I have some library privileges but you might be able to dowload
> a pdf at:
> http://www.psychosomaticmedicine.org/cgi/reprint/44/5/461
>
> I have to give tictactux an apology. From what I read, it is
> becoming clear that using beta blockers *can* improve one's
> performance. It then seems a little unfair in
> competitions/audition to have some use them and others not.
>
> Using them in a non competitive context is, however, a whole
> different story.
>

I find the attitudes about beta blockers from those who don't suffer performance anxiety to be reminiscent of attitudes I've heard about anti-depressants. There isn't a huge stigma about taking drugs for asthma or hypertension, but there is a stigma regarding medicating clinical depression or anxiety- interesting, considering that all of these are physical ailments that have a component in mental and emotional stress.

Sure, I put performance anxiety on a different level than clinical depression or anxiety, but the fact remains that there are people who are technically, musically, artistically capable and who suffer performance anxiety despite their more than capable abilities. Different methods work for different people- therapy, relaxation techniques, valerian, a drink or a cigarette to calm the nerves, whatever.

I'm anti-drug in general, but when nothing else worked despite a heckuva lot of efforts, holistic, visualization, and otherwise, I tried beta blockers. Did wonders. No, I didn't feel like I was magically capable of anything I couldn't do in my practice room. Did it affect motor skills? Not anywhere that I noticed- but I had, repeatedly in the past, noticed that debilitating performance anxiety had hugely tightened me up enough to affect motor skills.

I never took BB's for every performance, only when other methods didn't seem to ease the anxiety enough. The bottle ran out months ago and I haven't had a chance to refill it, but have had many gigs since then. But over a year or two, they gave my body a chance to learn how to NOT go into an automatic, self-defeating response. I experienced a similar thing years ago with anti-depressants, where after 2 years of taking anti-depressants, experiencing life without debilitating depression, my body learned how to not go into that cycle without the use of drugs.

The body's an amazing thing, different people find different solutions. And for some, chemical imbalances make all but chemical solutions inoperable. I'm not saying that that's the case for everybody, or necessarily for 25% of the classical musicians out there, but I grow weary of hearing people who don't experience incurable anxiety criticize people who do. As someone wrote earlier, people who resort to beta blockers don't tend to do it before trying a heck of a lot of other methods first. The idea of being unfair for use in competitive venues... try not allowing people their morning coffee as well, and see how that goes over...

Imagine an audition with 10 people; each one masters the piece while in the study. Every one - understandably - suffers from various degrees of nervousness, or stage fright if you like. That nervousness will bring down their performance down to say 85..95% of what they'd be able to deliver.

Now three of them gulp a BB before the audition, thus alleviating their nervousness. Those three now can give it full throttle while the other ones remain at 90%.
Compared with the "sober" group, the "doped" group did improve their performance. Not by magically growing a second pinky but by removing the impediment. They did not improve their performance relatively to what they could tape-record alone in their study, agreed. But taking a medication gave them an advantage over those who didn't. That is my concern.

> But taking a medication gave them
> an advantage over those who didn't. That is my concern.

Well, let's ban migrane medication while we're at it; after all, it's a drug that would most certainly improve one's performance if a migrane were to happen during an audition. Or asthma medicine for singers ...

The study is quite sound and well designed.
10 musicians on BB and 10 on placebo.
All players recorded music without an audience, then with an audience
1- body response to stress was measured (heart rate,adrenaline levels,...).
No audience -> no difference between BB and placebo.
Audience -> big difference between BB and placebo.
Little difference in stress level in BB between audience and no audience perfromance.
Are beta blockers significantly decreasing stress levels vs placebo?
The answer is yes.

2- Musical quality was assessed 2 ways:
A- give a passage of fast note appearing multiple times in the piece. Was the performer able to play it the same way consistently?
BB and PLacebio did similarly without audience
BB did a better job than placebo when performing with an audience.

B- One (and only one) pro player rated the performance as being technically
hindered by stage fright. In the beta-blocker group, in concert, only one
performance was judged as technically worse, 7 same as without audience and 3 as better than without audience. For the placebo group, the pro rated 9/10 perfromances to be hindered by stage fright.

a. Only 20 in a study is likely inadequate for much of a conclusion. Of the 10 on BB where 5 without significant stage fright?

b. They included musicians who did not suffer from stage fright in the study? Sort of like giving anti-depresants to happy people. No control for whether the non-afflicted would benefit. They got five musicians w/o significant stage fright to take the drug? wow.

> ginny,
>
> The study is quite sound and well designed.
> 10 musicians on BB and 10 on placebo.
> All players recorded music without an audience, then with an
> audience
> 1- body response to stress was measured (heart rate,adrenaline
> levels,...).
> No audience -> no difference between BB and placebo.
> Audience -> big difference between BB and placebo.
> Little difference in stress level in BB between audience and no
> audience perfromance.
> Are beta blockers significantly decreasing stress levels vs
> placebo?
> The answer is yes.
>
> 2- Musical quality was assessed 2 ways:
> A- give a passage of fast note appearing multiple times in the
> piece. Was the performer able to play it the same way
> consistently?
> BB and PLacebio did similarly without audience
> BB did a better job than placebo when performing with an
> audience.
>
> B- One (and only one) pro player rated the performance as being
> technically
> hindered by stage fright. In the beta-blocker group, in
> concert, only one
> performance was judged as technically worse, 7 same as without
> audience and 3 as better than without audience. For the placebo
> group, the pro rated 9/10 perfromances to be hindered by stage
> fright.
>
> -S
>

I posted my beliefs about this subject in earlier threads including this one....but just to reiterate, prompted by your keen observations:

***

Frankly, since my name is mentioned at the top of this thread, I don't give much of a hoot who agrees with me or doesn't or who feels warm and fuzzy to whom.

There's just so much looking inside oneself to see into the heart and mind of one's neighbor, so much attempt to universalize one's own experience. It's ridiculous for people to care so much about making someone else agree with them.

Yet it's easy to see why people get so aggressively defensive. Occasionally it may be an enjoyment of stirring up trouble. But most of the time it's because someone else has said, in effect, "No, you don't know how your life works, I know how your life works, so ditch that idea and listen to me instead."

If we give no one credit here for anything else, let's at least give everyone credit for knowing more about themselves than the rest of us do.

Hmmm...this is all starting to read like a Barry Bonds issue in the orchestra. Believe me, this set of uninformed ears would never recognize a perfectly played composition, only a glaring discordant blatt or high-pitched whine from the brass or wind sections. That is not likely to happen.

Perhaps every orchestra or symphony needs its own Yoga master to help members relax, perhaps a group session a half hour before the curtain opens.

"Perhaps every orchestra or symphony needs its own Yoga master to help members relax, perhaps a group session a half hour before the curtain opens."
=================================================

In fact, a relaxing massage service - with meditation style background music - is offered to musicians of the orchestra (at a price) at Orchestra Hall Chicago before just about every performance by a spectacular masseuse. Some take advantage of it, others not.

That's fine. It works for some. It does not work for others. Even others that practice meditation on a regular basis.

The point is that BBlocker's are not performance enhancing for those with debilitating enough personal social anxiety problems. Everyone is different - and by a wide margin. Individuals should not be stigmatised for needing treatment for what is considered by the psychological profession as a legitimate medical disorder. This adversion to medicine (which isn't even psychoactive but controls physical symptoms) amounts to discrimination.

I've worked with many students on this and have come to understand the prejudice and stigma attached to such conditions. Perhaps the ignorance regarding the subject will pass someday soon.

I think you make a terrific suggestion and don't mean to point any of what I've said toward you at all. I hope that you understand that I am using your good ideas as a springboard toward giving some context re: this issue.

The kind of adventure of finding a new line of work for those that simply need medical assistance? Would one say the same to a diabetic or heart patient?

I've had some student's professional success depend on whether they got that kind of medical assistance or not. They did so at my insistence and against some of the same misconceptions I am reading right here in this thread. Some of the views are so Calvinistic and Puritanical that one really has to wonder why some would grasp so tightly to them.

Having two children in school age I'm quite worried about the increasingly liberal prescription of "levelling" drugs in order to make people "fit". If that makes me calvinistic or puritan, then be it...

Realising and not denying that one has a medical condition (psychological or physical - and that's not entirely accurate as the two work synergistically) seems not a decision made based on weakness but of strength.

Everyone has to make that very important decision for themselves and one can understand the dilemma one faces, especially with children and the influence of Phrma lobbyists - the most powerful lobbying effort in the history of the world.

But part of the learning process about one's own self at near professional performance age level is part of learning to take on the personal responsibilities of being an adult.

Playing at the amateur or semi-professional level takes no less serious consideration as it's all based on the same principle. If something is causing you a problem you try every constructive way of fixing it - non-psychoactive or psychoactive medication under the supervision of a physician being the last resort.

I used to have horrific stage fright, and still get the jitters now and then. But I've found ways around it. Ways around it that, in addition to helping me get past stage fright, have changed my musical style dramatically and made me a much better player than if I'd never tried to find ways around it.

Getting over stage fright, for me, has been and continues to be an exploration into different aspects of making music and of the performer-listener relationship. Had I just medicated it, sure, I'd have a calmer stage presence, but I'd also most likely never have found my own musical voice.

That's my take on it... I don't think so much about medication as an unfair advantage, but rather an easy way of removing a problem, a problem that in itself can actually contribute, indirectly, in many positive ways to the experience at large.

If anything, I'd suggest (completely unfounded) that the beta blockers only help to increase the ever-widening gap between the performer and the audience. A bit of nervousness and agitation is a sign that you care about the people you're playing for.

"That's my take on it... I don't think so much about medication as an unfair advantage, but rather an easy way of removing a problem, a problem that in itself can actually contribute, indirectly, in many positive ways to the experience at large.

If anything, I'd suggest (completely unfounded) that the beta blockers only help to increase the ever-widening gap between the performer and the audience. A bit of nervousness and agitation is a sign that you care about the people you're playing for."
----------------------------------------------------------------------------------------

I'm truly sorry but it's odd to me how individuals universalise their own problems for others.

We're not talking about the usual pre-game jitters and butterflies that inspire. That's all absolutely necessary. That's not what's being discussed here.

We're, once again, talking about legitimately diagnosable medical conditions that completely take one out of the game. What again is wrong with treating that kind of medical condition?

Would one take away any medication that improves the quality of life after all other resources are exhausted?

BBlockers are meant to provide compensatory relief for those individuals that need them. That's not enhancement in any playbook I've read, it's simply relieving a medical deficit.

The type of disassociation that you're perhaps refering to between performer and audience simply doesn't exist if the medication is used in the proper dosages and under appropriate conditions for the appropriate individual performers. As I've seen it taken, BBlockers actually allow one to be more "one's self" - with the appropriate amount of butterflies and exhilaration and joy about music making.

Certainly, any audience would be inclined to pick up on that.

Gregory Smith

On edit: After reading the original UBC article at the top of this thread once again, I would have to say that it was the most inaccurate, sensational, and almost pornographic piece of journalism I've seen in some time.

>
> I'm truly sorry but it's odd to me how individuals universalise
> their own problems for others.
>

Gregory,

There is no question where you stand on beta blockers for yourself from your posts now, and many years ago.

I infer from your posts that you make your own students aware of beta blockers as an option for improving their performance, or at least for eliminating what you believe is medically-significant performance anxiety.

Should one of your students come back from a physician who has refused to prescribe the drugs because the problem was not deemed medically signficant or treatable in that way, what would your reaction be?

And, do you ever discuss with your students what they should say to a physician when they go in for a diagnosis, or do you merely tell them that they might wish to consult a physician and stop at that? Do you specifically tell them about what you believe the performance benefits of specific drugs are, or do you simply tell them that they should see a doctor for advice on how the problem might be treated?

I think Mr. Smith has expressed how I feel about this the best of anyone in this discussion.

I'm really kind of surprised at some of the contributions to this discussion. The idea that beta blockers give a performer an unfair advantage over those performers who don't need to take them strikes me as absurd.

Debilitating stage fright, in my experience, is like playing with one arm and half your tongue tied behind your back. Beta blockers, for me, just leveled out the playing field. The argument that beta blockers are "performance enhancing" is as ludicrious as suggesting that an athlete suffering from asthsma who uses their inhaler before or durring a game has an unfair advantage over those athletes who do not suffer from asthsma.

There are two basic points and in the end, I think we are more or less all agreeing.

1- If one does suffer from stage fright, BBs are an option that one should consider and not be ashamed of. It should also be done under the supervision of a physician and preferably in conjunction with other stress managing techniques. I don't see why, anybody would ever want to prevent somebody from using meds for a well documented medical condition.

2- Everybody, I mean *everybody*, experiences the effect of stress on their body. Heart rate goes up, adrenaline kicks in, ... Some experience it less than others and can control it to the point that the performance is not hindered. However, BBs almost always attenuate the body response to stress, and, according to some studies, can improve the musical performance. In a competitive environment (audition,competition), one cannot help to wonder if the BB users, whether they do need the pills or not, have an unfair advantage over the ones that do not.

"...whether they do need the pills or not, have an unfair advantage over the ones that do not."
------------------------------------------------------------------------------------------

Hi Sylvian -

I hope that you do not mind that I address what you posted to TonkaToy.

If one thinks that their individual reaction to the stress of competition is hindering their performance, it seems to me that it's a person's individual decision whether or not to seek help or not by whatever means that actually reduces those hinderances...medication being the last resort.

This will indeed give them an advantage over those that know that their individual reaction to the stress of competition decreases their own abilities to the point that it is adversely effecting them and then choose to do everything about it short of medication.

I don't see how the fair/unfair equation enters into that scenario - except to say that perhaps there are those that are not aware of the benefits of this medication and out of ignorance, haven't taken it.

Or that they are aware of the medication and a societal stigma or some sort of personal denial about performance anxiety in general has effected their judgment convincing them that there is something unfair, unethical or immoral about taking it.

"I infer from your posts that you make your own students aware of beta blockers as an option for improving their performance, or at least for eliminating what you believe is medically-significant performance anxiety.

Should one of your students come back from a physician who has refused to prescribe the drugs because the problem was not deemed medically significant or treatable in that way, what would your reaction be?"
-------------------------------------------------------------------------------

As in every other case involving medicine, seek a second or third opinion...from those doctors that are aware of the literature about performance anxiety. Doctors that are active on the lecture circuit or speak at conventions are usually the ones most likely to know the literature since they take BBlockers themselves if they need them. And those are the doctors that are in the best position of all to understand whether their patient actually needs medication at all.

Actually, the student's tuition includes a substantial amount for student health services. I have not encountered a case in my 25 years of teaching where these services have refused psychological or other services to the student's satisfaction. Perhaps my students are just lucky but I don't think so. It takes a specialised staff of physicians to help those that are at a particularly stressful time in their young adult lives.
----------------------------------------------------------------------------------
Ghuba:

"And, do you ever discuss with your students what they should say to a physician when they go in for a diagnosis, or do you merely tell them that they might wish to consult a physician and stop at that? Do you specifically tell them about what you believe the performance benefits of specific drugs are, or do you simply tell them that they should see a doctor for advice on how the problem might be treated?"
-----------------------------------------------------------------------------------

I simply ask them if they are at a point that they think they need medical intervention. If they say yes, I advise them to seek out student health services and remind them that they can get the medical advice and attention, psychological and otherwise, that they are already paying for (that motivates them to a great degree in this day and age of medical costs).

If they say no, I ask why not and take a short break to explain what I know about the subject as reflected on this BBoard.

My one and only concern about beta blockers is being careful how they are used. I have to take them for high blood pressure treatment (along with a mild heart condition) and have learned that certain allergy drugs don't work well alongside these. I've had an incident of rapid and irregular heart rate after taking the beta blockers and Sudafed for sinus problems. (I no longer use Sudafed.) And, I go in for a check up every 3 mos (complete with blood work) for the high blood pressure. So, be sure you're not taking other stuff as well because you could end up in a lot of trouble in a hurry. And, you really need to have a check-up from your physician before using beta blockers (IMO).

Excellent advice Brenda. My understanding is that Inderal also masks certain symptoms of full blown or emerging diabetic conditions (my teacher told me about his conflict with this class of meds because of his heart disease and diabetes). A responsible doc will always take a medical history and should perform some tests before prescribing.

I have no experience with Beta Blockers. I also don't know much about them, and therefore am in no position to judge their effectiveness, or to judge anybody that takes them. Gregory Smith seems quite knowledgeable about the subject, and what struck me is that he mentioned a few times that they would be recommended by him as a "last resort".

What I do know is that there are psychological techniques to overcome stage fright. For some reason, these don't seem to be commonly taught amongst musicians yet. As a student I read many books on sports psychology, and figured out ways in which this field (which is quite developed) can be applied to music performance. Since then more "music psychology" books have been written. For starters I would highly recommend books by Don Greene (check out www.dongreene.com) His techniques would provide at least one of the "constructive ways" of fixing the problem of debilitating performance anxiety.

I'm not on a beta-blocker but rather an anti-anxiety drug (in combination with an antidepressant) for the past several months. While some of the techniques for controlling nervousness that my old teacher taught me helped, I still had bad anxiety attacks on stage, often resulting in not playing as well as I would like. Since taking the drug, the quality of my practicing and performing have been much better, I have not experienced an anxiety attack on stage, though I had a minor one during my piano exam last August.

Meri

"There is a difference between being flat and sounding in tune, and being in tune but sounding flat. The first I can live with; the second I cannot."

I appreciate Gregory Smith's approach to this question (Oh, and I also appreciate the great mouthpieces he makes!)

For me, the stress of an audition manifested itself not with missed notes or loss of technique but with a shaking lip. I started calling it my audition vibrato since it never seemed to happen in nature otherwise. There is a good ale made in Missoula, Montana called "Moose Drool Ale". It would be charitable to describe the sound I made as an imitation of a very sick, drooling moose.

Per Licourice's post I prepared thoroughly, I meditated, I focused, I played to the listeners, I played for myself, I imagined the listeners were not there (nude or otherwise), I ate bananas, I cared/didn't care, whatever. I tend to be very calm before such events anyway and show none of these problems warming up. It was just, bang, there it was.

I consulted my doctor and got a beta blocker prescription. The sick moose sound was gone....no shaking lip. I didn't feel mentally flat and with the new calmness and lack of worry about "audition vibrato", I was able to carry out my performance plan.

Yes Lic. - Don has coached many a musician before opening his website a year or two ago. I have known several non-Chicago professional musicians who have had private coachings with him. I believe they mentioned a new book of his having come out in the last couple of years.

Students and pros alike have benefitted from short courses of one of the 5 branches of psychology namely Behaivorism. This includes Behaivoral/Cognitive/Rational Emotive/Cognitive Behavoral/ or Rational Living therapies.

Finding a professional specialising in these therapies or a self-help book that can be used as reference or a guide is a fine way to understand how to change one's thinking process.

Another series of books having to do with sports as metaphor are the Inner Game of Tennis books along with offshoots The Inner Game of Music, etc.

I personally know a band director who was recommending beta blockers to his students. His school had quite a few all-state musicians and even got to play at the Midwest convention in Chicago. I found out about this practice when I taught their top clarinet player. She had already made state three times and was fourth in the state her jr. year. Her senior year, she did not make state. Shocked, I wondered how this was possible. She told me that the previous years she was on beta blockers, as were many other students in her band. Unfortunately, her doctor refused to prescribe them to her that year, and she folded under the pressure of an audition.

Beta blockers certainly do work. However, taking them for nonmedical reasons may not be a wise decision. Additionally, they give an advantage to those using them over those who do not - in other words, it is a form of cheating. Eventually, it may go one of two directions - everyone has to take them to compete, or they are banned. Already, athletes at all levels are being tested for steriods. Will the day come that musicians have to pee in a cup before they audition?

Just a quick comment and most likely my last. I have already said enough. I gree with 99% of what you say and fully support the use of medication when necessary. I work in a schizophrenia lab and without medication, pretty much all patients would commit suicide. In a non officially competitive environment, I am all for it.

Now, with respet to fair/unfair. My only point is that from the study I read (not the ubc article) almost all musicians have their performance improved when using BBs. Not all need it, but all benefit from it. Should all use the drug?

I have never used BBs, as I always feel I am under control, but I still feel nervous. If I were to participate in a competition (a very unlikely event I must say), I would seriously consider a prescription only because somebody else might be using it and I am at a disadvantage to that person. Where do you draw the line?

The parallel with performance enhancing drugs in sport does not seem this far fetched to me.

Just my 2 cents, and as I said earlier, my 2 cents aren't worth much considering my limited knowledge of both medical and musical worlds.

As a physician, and a clarinetist, I thought I would chime in to clarify a few points. Lots of great discussion here that's been very interesting and enlightening.

I believe the medical field considers performance anxiety syndrome as a very legitimate disorder, and one that can be easily managed. The remainder of the chronic anxiety disorders however can be very difficult to manage. Beta blockers however, as many have pointed out, are certainly not performance enhancing, but simply blunt parts of "flight or fight" response that includes rapid heart beat, or perceived rapid heart beats, PVC's (premature ventricular contractions, also called skipped or irregular beats), sweating, tremor, and overall sense of nervousness. I think physicians like myself readily recognize the potential benefit of beta blocker use to an individual who is sufferring with performance anxiety, although would hope that relaxation techniques would also be pursued as well.

Short acting beta blockers are typically used, of which propanolol (Inderal) is the prototype, and as a generic makes the most sense. Longer acting beta blockers such as atenolol, metoprolol, nadolol, and others are not appropriate here due to their sustained release. These are used for hypertension, coronary artery disease, migraine prevention, among other conditions.

Side effects have been mentioned by some.......however these are generally related to sustained release long term use. Depression, lethargy, constipation can be problems here, but would not be expected with intermittent use of a short acting drug. Beta blockers can worsen asthma, but usually only a problem in an individual with uncontrolled severe asthma. Since beta blockers will slow the heart rate, individuals with a baseline slow resting heart rate (say 50 or less) and relatively low blood pressure may well feel lightheaded and be at risk for syncope (passing out). Finally, a cardiac conduction problem, such as advanced heart block is a contraindication, that could lead to dangerous syncope.

Lastly, I would expect you'd find physicians happy to help here. It's one the conditions we feel we can make a big difference for our patients. Many other acute anxiety disorders (such as panic attacks) patients seek us out for benzodiazepines (Valium, Ativan, Xanax, etc), and since beta blockers are unrelated, not controlled substances, not abused, we feel happy to help.

No. Only those that believe that they need it in order to help overcome what they believe is their own personal performance deficit in their own music performance-related lives. Others can continue without medication using other techniques than medication that may be as helpful if not more helpful in their particular case.

The point is that the individual has to decide for themselves if they need it based on their own unique experience, not on any statistical study in the abstract. As you know, statistics do not apply to individuals (which one has to admit that in this particular study, there's a smaller than small control group in relation to the general musician population).

"I have never used BBs, as I always feel I am under control, but I still feel nervous. If I were to participate in a competition (a very unlikely event I must say), I would seriously consider a prescription only because somebody else might be using it and I am at a disadvantage to that person. Where do you draw the line?

The parallel with performance enhancing drugs in sport does not seem this far fetched to me.

You would only be at a disadvantage if you did not perform your very best. That's the illusion of competitions - that you are competing with someone else when you are actually competing with one's self. If you believe that in your individual case, BBlockers relieve a deficit in your own ability to produce your very best, then you should by all means take them. It has nothing to do with the "others".

The medications are not performance "enhancers" as much as they are performance "allowers". As soon as one accepts that differentiation, the analogy to steroids simply vanish as pure fantasy. The two are simply not analogous on any level if one understand one basic thing:

That if we give no one credit here for anything else, let's at least give credit to those knowing more about themselves than the rest of us....or than from extremely small threads of woefully insufficient scientific research based purely on statistics. We would all benefit with the realisation that we all are not statistics but are individuals with individual needs and aspirations.

Gregory Smith

PS. Sylvian - I hope that I have addressed your questions as directly as you desired. If I am not clear or am still missing some point, please, I would definitely like to know what it is....

I'm curious about how many folk who've tried beta blockers feel that using them in competition is unfair. What I notice posted here, claiming unfair advantage, is from people who haven't tried them or perhaps firsthand understand what they do and don't do.

When I've used them, I haven't experienced the sense of "can conquer all"- I've still had the adrenaline rush of performing, the same rolling my eyes when I make a silly mistake (and hopes that it doesn't happen again!), a little of the normal nervousness of performing. The BB's taken the edge off, helped me get past it and move onto the next notes, not let the mistakes cause me to snowball into the downward cycle of one mistake breeding geometric progressions of more. I play a lot of memorized music, and a fair amount of improvising- a lot of potential for anxiety about missed notes to breed more.

I wrote earlier that I'd also been on anti-anxiety meds before (paxil)- same thing. Life still had its ups and downs, but the worries were from real reasons, and not "out of nowhere," stopping me in my tracks or making me unable to get out of bed in the morning. I think it's hard for people who experience only "normal" anxiety, nervousness, jitters, ups and downs, to fathom what it's like for those who have debilitating issues with it.

The idea of "unfair advantage" in auditions is equally nonsensical to me as the advantage of alertness coffee drinkers experience after their morning dose, or the needs of asthmatics or diabetics or the other myriads of folks taking meds before their auditions. The performance enhancement that the meds offer is to be able to keep a sense of reality about what's in front of you rather than allow anxiety to debilitate. I'm no doctor, but my understanding of steroids' contribution to "performance enhancement" differs by a long shot.

Are we truly a Darwinistic enough community to say that people who use a prescription drug for a medically recognized condition don't deserve the symphony jobs as much as those who don't have that condition to begin with?

My kudos go to those who recognize they have a problem and take active steps toward solving it, including medical intervention. As a concertgoer, I don't care who in the symphony uses meditation, who has a shot before the gig, who takes beta blockers. I care about hearing a good performance.

FWIW, I rarely perform classically, haven't taken an audition in years, tho I do gig often. I occasionally use BB's, but not for every gig. I used to be horribly debilitated by performance anxiety, to the point where I almost quit playing, and yes, that was after trying everything under the sun that I could find before the drugs- from visualization and meditation techniques to clove cigarettes. I feel fortunate to have found a solution in the BB's before quite reaching the quitting point.

Lastly, I would expect you'd find physicians happy to help here. It's one the conditions we feel we can make a big difference for our patients. Many other acute anxiety disorders (such as panic attacks) patients seek us out for benzodiazepines (Valium, Ativan, Xanax, etc), and since beta blockers are unrelated, not controlled substances, not abused, we feel happy to help.

A close family member of mine is an ER doc and the hierarchy of diagnostic options always factors into the equation psychological trouble (as any standard evaluation would).

Without opening up a completely new can of worms, I know that ER docs refer patients regularly to psychologists as well as to pdocs or internists if a patient presents with Panic Disorder.

The use of psychotropic medications such as the ones you mention is a legitimate area of consideration for those in need. Many famous musicians at the top of their fields are reliant on anxiolytics or AD's on either a sustained medical dependence schedule or PRN basis.

<I'm curious about how many folk who've tried beta blockers feel that using <them in competition is unfair. What I notice posted here, claiming unfair <advantage, is from people who haven't tried them or perhaps firsthand <understand what they do and don't do.

It wouldn't bother me at as someone who understands how bad stage fright can be and who tried meditation, hypnosis (is that a cheat too?) and a variety of other techniques. BBlocker allowed me to unlearn a bad response to playing and I have not used them for many years. Had I not be able to play in high pressure situations using them I couldn't have unlearned the response.

My younger son is relatively good musically, first chair at a huge high school since age 14, state honor band, good awards at the competitions and the usual pretty good clarinetist kid stuff. He has only had one taste of stage fright and played poorly at one competition. He was able to learn from the experience and can perform under very stressful and competitive situations. He says it all concentration, that and bananas. My other son simply does not even understand stage fright at all. He plays better with an audience as far as I can tell!

However, a friend's daughter, uses them for auditions. They only school she didn't use them for did not accept her, the others offered her scholarships because her nerves didn't get in her way of showing what she could do.

Did she 'cheat'? not to my mind. My son does not need them to play at or even better than his current level of musicianship. My friend's girl absolutely does.

Should we give them to teens? I haven't needed to look into that happily.

> However, a friend's daughter, uses them for auditions. They only school she
> didn't use them for did not accept her, the others offered her scholarships
> because her nerves didn't get in her way of showing what she could do.

So basically we encourage our kids to gulp a pill if something doesn't work. Great. :-/

NB: I no longer really care under what circumstances adults take drugs. So I am not challenging those who have good reason to take BBs etc.

I wouldn't disagree with yours and other's concerns about children of non-professional audition age taking these medications - especially if they have not been properly diagnosed with a severe anxiety disorder of some kind.

My understanding is that that severe of a disorder is rarely diagnosable at that early an age and it is entirely possible that some misguided "stage mothers/fathers" put undue pressure on their kids to "win" (as if in a soccer game) by having pressured their children to be "diagnosed" and medicated. But those misguided parents or school music directors are missing the point of what competition is.

At this tender age, non medication techniques would seem to be called for and applied to competition as just a natural part of the growing up process. That kind of a learned or an acquired control is what tempers or forges the musical personality and encourages self-mastery. This allows these young musical "sponges" to blaze their own unique musical path through an acquiring of general self confidence.

When I was teaching, I suspicioned some parents gave "slow 'em down, quiet 'em down" drugs to children to quash behavior problems in school. I'm not so sure most behavioral problems weren't caused more by home environment than genetics.

Perhaps short attention spans are encouraged by videogames, phones with full entertainment systems installed, and a choice of the world's TV stations to watch at any hour of the day. Add to this technological smorgasbord the slew of parents wanting only to placate their children and there you have it: the functional/disfunctional modern family unit.

I defer to the musical experts on drug use to enhance performance, noting only that I do vaguely remember reading somewhere about betablocker traces found in Elvis' bloodstream.

> However, a friend's daughter, uses them for auditions. They only school she
> didn't use them for did not accept her, the others offered her scholarships
> because her nerves didn't get in her way of showing what she could do.

So basically we encourage our kids to gulp a pill if something doesn't work. Great. :-/

NB: I no longer really care under what circumstances adults take drugs. So I am not challenging those who have good reason to take BBs etc.

--
Ben

She was 18 and legally an adult at the time. I know the family well. They are very intelligent and capable of making life decisions whether you or I approve.

Bottom line, the beta blockers would not help my sons significantly. Without bblocker's my friend's girl cannot get past her biochemistry to show her level of ability.

Also regarding stage parents and beta blockers, Greg, my friends seem support their daughter's decision to go into music. I don't believe it is what they would have selected for her. I understand that they spent a fair amount of time with her discussing her decision.

I supose there are stage parents out there, but this is not the case with my friends.

This is a fascinating thread. I briefly took propranolol to combat physical symptoms (akathesia) of an AD I was on. They work wonders in terms of reducing the body's response to adrenaline. I never took them within a performance setting, but unlike booze or pot I could see beta blockers as actually making a positive impact on someone's ability to play music. After all, they won't teach you a b-major scale, but if youi know how to play it, they'll help you actually be able to do so when everything is on the line.

Here's an interesting point which may additionally fuel the "level playing field" debate: the PGA lists beta blockers as a banned substance, because they recognize that a pro with a putter in his hand is DEADLY when there's no tremble or shake in his grip. Food for thought....

Yes. There obviously is some overlap between the two disciplines although I would suggest that even though I am not a golfer on the pro circuit, there are too many dissimilarities to make the kind of apples to apples comparison.

Don't get me wrong because I like golf but.....simply because the PGA has decided to ban BBlockers doesn't mean that they are anymore enlightened than other groups re: issues of medical well-being needed to perform classical music at the highest level.

At least I wouldn't look to a PGA governing body for any form of progressive or enlightened thinking as I know the term - especially when related to the performing arts.

Golf is mostly about preserving tradition and holding on to "traditional" ideas. Need I mention that Augusta is still allowed not to accept ladies or that the dropping of color and religion barriers lagged far behind what existed in the "outside" world"?

Put that together with a governing body or committee representative of such a group (those kinds of bodies more oft than not reflect rather than lead it's members) and I doubt that the PGA leads the way in terms of enlightenment about such matters.

Mr. Smith is certainly a huge proponent, but the fact remains that people are doping in order to perform at higher levels. His last post, which slams the PGA, is an ad hominem attack which does not address the issue of why the PGA prohibits the use of beta blockers. Reducing trembling to enhance performance is absolutely an apple-to-apple comparison between golf and music. True, golfing as a whole is quite different from musical performance, but the example sited - betablockers for putting - is spot on.

Given the PGA's history of intolerance, I'll accept the argument that they are unenlightened. However, other international organizations which prohibit beta-blockers include:

Yes, I see all of the sports organisations you've listed - except aeronautics which understandably have very highly restrictive medical regimes because of side effects and the position of public safety that's at issue. And once again, I would be loathe to think that we as musicians would make ethical decisions, policy, etc, or take specific guidance from sports organising bodies.

(By the way, Ad Hominem is translated literally as "to the person" so I hope that the public organisation that I mentioned out there hasn't been "personally" offended by my remarks! :^) ).

I think that the AFof M. and musical organisation managements understand this issue very clearly from the notes I've read from conferences on the subject and from speaking with administrators at the highest level of our profession. Same thing with physicians and musicians. We're all pretty much on the same page with the issue - again if under medical supervision.

I and others have addressed your earlier post by asking you to reread the entire thread. Your misunderstanding of the term of "doping" and it's differentiation from the concept of "allowers" (enabling those with what they perceive as psychological deficits) seem to me to be somewhat discriminatory in nature. Also, I've addressed quite specifically the medically unwise use of beta blockers with children.

You seem to feel as though people cheat when they use something other than their own free will to overcome these inherent psychological deficits - deficits that each of us has to decide for ourselves whether or not we have. That's a pretty extraordinary assertion to make in light of one's need of being free to determine one's own individual's medical or psychological needs. In fact I would say that your assertion is highly contradictory when it comes to the issue of free will itself - as in the free will to choose not to be debilitated when performing music by taking BBlockers.

I can understand the perceived unfairness in the experience you recite in an earlier post - that is unless one realises that the medication is available to all that make their own personal decision that they need to use it as a last resort to make up for their own perceived psychological deficit.

I would hope that you would also see that individual right to treat for psychological deficits no differently.

The process of living seems to consist in coming to realize truths so ancient and simple that when stated they sound like barren platitudes. They can't sound otherwise to those who haven't had the realvant experience. That's why there's no teaching of such truths possible and every generation starts from scratch.

I have several past students and several famous professional colleagues in the world that have wonderful careers in music that would have been otherwise impossible for them if they had been subjected to the kind of discrimination that one sees when it comes to this psychological deficit.

They would otherwise be applauded if they had overcome some physical ailment to triumph over tragedy. The stigma of another's psychological "weakness" or the weakness of the another's "will" is evidently, in some cases, still with us today.

Where is the line between adjusting for a natural disadvantage vs. performance enhancement beyond one's natural skill level?

Personally, I would consider it highly unfair if I couldn't wear my glasses because they were considered performance enhancing.

I don't think BBs perform the same service for musicians as steriods do for atheletes. I do think all performers have to deal with stage fright, but I also think that stage fright is a disadvantage, and that taking BBs, doing yoga, whatever, are ways of countering that disadvantage, rather than enhancing performance beyond their natural innate level or trained skill level.

Your literal translation of "ad hominem" is correct. However, in practice, an ad hominem argument can be used against one or more individuals. For example, this is from Wikipedia:

"An ad hominem fallacy consists of asserting that someone's argument is wrong and/or they are wrong to argue at all purely because of something discreditable/not-authoritative about the person or those persons cited by them rather than addressing the soundness of the argument itself."

You also mischaracterized my views on the use of medicine. I take medicine every day for allergies. As for "psychological deficits", I have a family member with schizophrenia who must take drugs to function rationally. And I certainly would not deny beta blockers to someone with a heart condition or a severe anxiety disorder. 1/4 of all professional musicians in America were using beta blockers in 1987, and I have no doubt that number is much higher today. I assume that at least 90 percent of these people are not taking beta blockers for medical reasons, but instead are trying to get an edge.

However, from what I am reading from you, you consider anyone who is helped by playing with beta blockers under pressure to be suffering from a "psychological deficit". I do not. Those who are taking beta blockers solely to play a little bit better are guilty of doping.

You constantly cite doctors. Doctors are in the business of prescribing medicine. It is financially advantageous for them to do this. And since the use of beta blockers helps musicians in performance with few side effects (except for the previously mentioned asthmatics and people with low blood pressure), they have no problem prescribing them. However, medical ethics are not the same is what is ethical in general. Athletes are notorious for doping, usually in ways that are not medically harmful either, but people who respect the sport and fair competition see them for what they are - cheaters.

Were musical competitions a huge international sport like the Olympics, I have no doubt that beta blockers would be banned. However, since our little niche is off of most peoples' radar, it is not scrutinized as much.

Why the fuss? If taking drugs (aspirin for a headache, beta blocker for nerves, whatever) makes you play better, take them if you wish. If taking steroids makes you play baseball better, take them if you wish. Most of us could take beta blockers and still not play the clarinet as well as Gregory Smith. Most of us could take steroids and still not play baseball as well as Barry Bonds.

I believe that I and many others here have absolutely and directly addressed all of the issues (argument) here - and in spades. For some reason you don't seem to agree with the premise of the argument. That's an entirely different thing.

---------

JKDD>"I assume that at least 90 percent of these people are not taking beta blockers for medical reasons, but instead are trying to get an edge."

On what authority do you make these assumptions about for what reasons and for how many of "these people" are trying to "get an edge" as you put it? On what authority do you think you can judge what are and what aren't medical conditions for others? Do you not consider psychological problems, mental blocks, psychological burdens, etc, the equivalent to that of physical ones (to whatever degree that they present themselves)?

--------

JKDD>"...you consider anyone who is helped by playing with beta blockers under pressure to be suffering from a "psychological deficit". I do not. Those who are taking beta blockers solely to play a little bit better are guilty of doping."

Then you seem to be assuming that you know others better than they know themselves. This is the main complaint - that that type of observation seems to me to be rather harsh and judgmental insofar as other's motivations are concerned. It also demonstrates a profound misunderstanding of the nature of the problem performing musicians are trying to overcome (let alone how they are trying to do it).

I believe that someone a few posts up said that they just wanted to get back to their own "normal". One simply can't play beyond their own "normal". How can one play beyond their own "normal". Who decides that normal - you or the individual that knows themselves best? Being relieved of the distraction that any psychological issues enter into one's performance is the equivalent of attempting to find one's own psychological baseline so to speak. That's not "enhancing", it's simply allowing one to be one's self.

As far as physicians and ethics are concerned, there is a whole branch of medicine that has emerged specifically addressing performance anxiety as well as all musicians' health issues in the arts. One very large component of that well established and respected branch of medicine deals with the psychology of performance. One of those sub-specialties deals with medication and it's proper usage. That branch, along with the others, is perceived to be just as legitimate as the rest. I can assure you that my posts reflect the philosophy of that branch of medicine.

Profit motive aside (we all know the effect of Phrma and their lobbying machine) I can't think of what you may be intimating about musician's doctors. Is it that doctors that help musicians with their psychological blocks are in it purely for the money? Inderal is one of the least profit driven meds in the entire industry. That they are somehow conspiring with musicians? Reread some physician's posts in this thread and in the links contained in the first post as well as the link that I posted above. I just don't understand that kind of thinking - unless of course one actually believes as you seem to insist (erroneously) that BBlockers allow one to perform over and above what one is inherently able to do...that they suddenly become "super-players" of some sort.

-------

JKDD>"Were musical competitions a huge international sport like the Olympics, I have no doubt that beta blockers would be banned. However, since our little niche is off of most peoples' radar, it is not scrutinized as much."

Mine and many other's view of the artistic community is that they are, and have to be by nature, very open-minded, sensitive, intelligent, and in philosophy, less likely to be judgmental toward their fellow human beings. I think that the artistic community as a whole is less likely to take as puritanical a view of the world that, in the imaginary scenario that you paint, would attempt to determine for others what is best for them by universalising for all others based soley on one's own experience.

"Profit motive aside (we all know the effect of Phrma and their lobbying machine) I can't think of what you may be intimating about musician's doctors. Is it that doctors that help musicians with their psychological blocks are in it purely for the money? Inderal is one of the least profit driven meds in the entire industry."

It's not the profit motive, but rather the whole paradigm of a good deal of the medical community today. So much of medicine is a treatment of symptoms rather than causes, and so many problems that are treated with medication could be prevented by something as simple as lowering stress. A doctor can't very well prescribe someone a chill pill, though frankly I think it would be a good idea in many cases.

The prevailing tendency, though, to give such priority to "how can we un-sick ourselves?" over "why are we sick in the first place?" is what makes me question the wisdom of our medical system. The doctors themselves, by and large, mean well, and do pretty well within the confines of our modern medical paradigm.

People are perfectly happy to pop a few pills, not so happy to make lifestyle changes. Telling a person "you're antsy because of a chemical imbalance. we can offset it with a pill and you can continue your hectic, unhealthy routine" is a heck of a lot easier than telling them "you get 3-5 hours of sleep a night, you have an unhealthy vendetta against the first chair clarinetist, you spent fifteen hours this week debating how to save $2 on long distance, and you argue with your neighbor every morning about his trees dropping leaves on your driveway. This is wreaking havoc on your system, causing a chemical imbalance, which, surprise surprise, makes you antsy. STOP IT."

> you get 3-5 hours of sleep a night, you have an unhealthy vendetta against the first chair clarinetist, you spent fifteen hours this week debating how to save $2 on long distance, and you argue with your neighbor every morning about his trees dropping leaves on your driveway. >

You forgot to mention too much coffee and a diet consisting largely of fast food and Twinkies.

Seriously, though, telling someone who has significant performance anxiety to basically get over themselves is just about like telling someone who has a severe depression to just cheer up.

Most women give birth without major psychological trauma. A few, however, suffer postpartum depression severe enough to cause them to be a danger to themselves and others. It has nothing to do with their personality types or their intrinsic mothering abilities.

Some (most?) of us have no problematic performance anxiety. Some of us do. It has nothing to do with our personality types or intrinsic musical abilities.

And some of us who do have performance anxiety can handle our situation with a timely banana, while some of us require (or prefer) the banana effect in pill form.

Is it "doping" to eat a banana? Two bananas? How many pre-performance bananas should we allow a musician to consume before we alert the DEA?

you get 3-5 hours of sleep a night, you have an unhealthy vendetta against the first chair clarinetist, you spent fifteen hours this week debating how to save $2 on long distance, and you argue with your neighbor every morning about his trees dropping leaves on your driveway. This is wreaking havoc on your system, causing a chemical imbalance, which, surprise surprise, makes you antsy."

I get usually 7-8 hours of sleep every night, I have no vendetta against anyone, I don't debate hours on stuff like you mentioned, I rarely argue with anyone and really don't care what leaves drop where. Still I have one of the worst cases of stage fright I know....

I respect many of the issues that you have addressed and agree with most of what you say, but you claim that the arts are or shoudl be " very open-minded, sensitive, intelligent, and in philosophy, less likely to be judgmental toward their fellow human beings". This debate is certainly not open minded.

Can you at least consider that:
1- One is not always the best judge about one's self.
2- There are musicians who abuse of beta blockers and/or take it illegally.

In your rhetoric, you suggest all BB users are well rounded individuals who are using them only to get to a "normal" state. It is as valid a point as suggesting they are all cheaters who take it to enhance their performance. I like to consider both side of the argument and recognize the necessity of BB to allow musician with stage fright to function, but I also see the potential and likely already occuring abuse of these drugs by some.

<It is as valid a point as suggesting they are all cheaters who take it to enhance their performance.>

I just can't buy that having experienced the difference personally and had my stage fright very much lessened using beta blockers after more than ten years of the ways you approve of not help at all. I remind you I spent time and money on therapy, hypnosis, and even was a part of a study at a major university.

The discussion at the study was about the burden we shared. These were wonderful musicians, who played with the major symphonies and orchestras in the San Francisco Bay Area. Job related stress is incredible. I assume you just have no empathy or don't perform under really high stress or something. All had, being intelligent people, tried a great variety of cures. Their jobs were at stake.

I look at my boys and my friend's girl. She loves music and wants to be a musician. She hopes to be a teacher who performs. Because of her lack of calmness under pressure, likely a biochemical nature, perhaps within normal, she will not be able to without assistance. My boys don't get stage fright, beta blockers would not help them. Mind you my boy was in competition with this girl for the various music awards given when they graduated. I did not think of her as having cheated, I understood how she could not play in public without the overwhelming physical response. She would have been robbed of the recognition of her ability and I would have been robbed of hearing her talent had a way not been found to conquer her fear.

After 108 posts, I do not think -- unless I missed something in this thread -- that we have yet seen a self-identified Board Certified Psychiatrist or licensed clinical psychologist or or licensed clinical social worker or psychiatric nurse weigh in with a blanket endorsement of beta blockers, or any endorsement at all. Perhaps one or more posters has this expertise but they have not identified such expertise in their comments.

We have seen endorsements from at least one physician who does not specifically specialize in psychological issues or psychiatry and of course from at least one prominent clarinetist who apparently has experience with the medical establishment and has studied such drugs. I am not discounting the possible expertise of these latter individuals, but I would suggest that if you have a psychological problem you consult with a licensed mental health professional. While physicians of many specialties can prescribe beta blockers and many other drugs for psychological problems, I am not sure why one would not consult the most appropriate and well-trained mental health professional one can find for a problem such as this and make sure that you are receiving the treatment a specialist would prescribe.

Most importantly, a clarinet teacher -- unless they also have a medical or psychology or social work or nursing license -- is not an individual licensed to diagnose psychological problems or provide treatment in any State of the United States of which I am aware. In the very unlikely circumstance that I am wrong in this belief, I would like to know in which jurisdictions clarinet teachers without medical or mental health licenses are permitted to formally diagnose and provide treatments for mental health issues.

And so it is clear, in the United States where most of the posters apparently reside, the use of a prescription drug requires that a medical professional believes that this is an appropriate treatment for you and is willing to sign a prescription accepting supervisory responsibility for your use of that drug.

If you are one of the many readers of this Bulletin Board who is under 18 years old, please remember that your clarinet teacher is not a doctor or a psychologist and in the U.S. cannot legally diagnose a medically significant anxiety problem (or any other diagnosable psychological condition) without a medical or mental health license. If you think you have a performance anxiety issue or your teacher says you do, see a doctor or a psychologist for diagnosis and possible treatment. Most importantly, if your clarinet teacher or your friend or someone else offers you a prescription beta blocker before a concert or audition, refuse it and see a doctor or a psychologist if you think you need the drug. Two fairly dumb things you can do in your life are to use prescription drugs without a prescription and to not see a doctor who may prescribe drugs when you do have a real problem. Don't let your clarinet teacher or band director or friend push you into making either mistake. And if you are over 18, you undoubtedly are well aware that a medical professional should be helping you with a performance anxiety problem that requires medical interventions, not a teacher or another musician.

> After 108 posts, I do not think -- unless I missed something in
> this thread -- that we have yet seen a self-identified Board
> Certified Psychiatrist or licensed clinical psychologist or or
> licensed clinical social worker or psychiatric nurse weigh in
> with a blanket endorsement of beta blockers, or any endorsement
> at all.

OF COURSE NOT ONE would give a blanket endorsement; NO self-respecting professional of any ilk would give a "blanket endorsement" of a drug. Even over-the-counter ones, never mind a regulated one. What were you expecting?

> Most importantly, a clarinet teacher -- unless they also have a
> medical or psychology or social work or nursing license -- is
> not an individual licensed to diagnose psychological problems
> or provide treatment in any State of the United States of which
> I am aware.

And again, not one has made any mention of diagnosing or providing treatment, only that such things exist and may be of benefit.

I'm not sure what you're trying to intimate here, George, other than throwing stones for no apparent reason. There has been no mention of obtaining the drugs illicitly or any blanket endorsements of the drugs, only what I opine to be balanced information and suggestions that if one does experience stage fright to a crippling degree then it might behoove them to look at treatment regimes (of which drugs are only one).

I quit smoking cold-turkey after twenty years. However, I was one of the lucky ones; quitting with the help of nicotine replacement therapy WORKS for more people than cold-turkey, hypnosis, meditation, and other non-pharmaceutical regimes. If you don't need nicotine-replacement - hooray for you. If you do - hooray for you. In either case you're doing yourself a favor and getting on with your life.

I do still believe that way about my fellow artists as a whole - and I do believe that there are open minded, intelligent, sensitive, etc, members of this BBoard community irrespective of our present and differing points of view. Willingness to engage in good faith debate in and of itself is an act of open mindedness IMO. (Perhaps those that choose to refer to legitimate use of medicine for psychological purposes specifically as "Doping" are lagging behind a bit - but hopefully they will reconsider after open discussions such as these.)

The reason that I have repeated that BBlockers should be used as a last resort is exactly BECAUSE one isn't always the best judge about one's self. (sorry for the caps, I don't know how to bold text here). Before that final decision is made, I've recommended to all of my students that they try everything possible to use other methods to gain some mastery and objectivity regarding their individual situation, ie. referrals to psychologists, reading, etc. Many others here have also contributed suggestions along those lines.

You said earlier that, "Music is not professional sport, we are not talking about *enhancing* one's abilities, but simply bringing stress levels under control in order to show one's *true* abilities."

I couldn't agree more.

And further you stated in a follow-up post that, "Nothing in what I read about beta blockers mentions enhancement of motor skills and/or musical knowledge. On the contrary, what I read is that the motor skills might be slightly impaired by beta blockers..." which further clarifies and supports your first statement.

You also state that my rhetoric suggests that "...all BB users are well rounded individuals who are using them only to get to a "normal" state."

Yes, to THEIR normal. Well rounded in the sense that they understand that use of BBlockers only go so far as to help one show their *true* abilities and that it is inherently impossible to therefore abuse them in an act of "cheating". That does seem to be a healthy way to approach this important and for many, life-changing issue.

There is a clear differentiation in mine and medical specialists' minds between enhancing one's performance beyond their innate capabilities (ie. Benzedrene's *sp?* that speed one up and allow them to work seemingly endless hours), and a medication like Inderal that provide COMPENSATORY results to help one achieve their own individual normal - sort of like the natural phenomenon of water seeking it's own level.

As to "abuse", I'm not sure that in the traditional medical use of the term how the use of Inderal could possibly be compared to the use or misuse of controlled substances (substance abuse). Perhaps it is a referral once again to those that "abuse" taking Inderal but don't really need it. Those that don't need it won't derive any benefit from it.

In fact, as you stated before, many will find that the side effects hinder more than help. Or that they in some way they don't like the feeling of taking them in one way or another due to side effects or they simply don't like the idea that FOR THEMSELVES, they don't want to be dependent on them. They are making legitimate decisions for themselves based on their own experience in exactly the same way that those who DO choose to take BBlockers.

To judge what's best for others based soley on one's own experience, (universalising for everyone else), is simply not giving an individual credit to be able to make decisions for themselves.

Sorry to say I've exhausted myself insofar as what I have to contribute to this thread. There are reeds to find and music to practice (not to mention a nice springtime in Chicago in which to get out and enjoy!)

>
> And again, not one has made any mention of diagnosing or
> providing treatment, only that such things exist and may
> be of benefit.
>
> I'm not sure what you're trying to intimate here, George, other
> than throwing stones for no apparent reason. There has been no
> mention of obtaining the drugs illicitly or any blanket
> endorsements of the drugs, only what I opine to be balanced
> information and suggestions that if one does experience
> stage fright to a crippling degree then it might behoove them
> to look at treatment regimes (of which drugs are only one).
>
>

Mark,

I have one very simple concern. If an individual has a problem like this, or any other medical or psychological concern, they should see the best specialist they can identify and let that person diagnose (and if necessary, treat) the problem.

My suggestion is that treatment options for any individual be specified by a specialist and that the individual not attempt to self medicate. I fully support the idea that each individual should have full access, without any kind of stigma or financial limitation, to the treatments that appropriate licensed professionals feel are state-of-the-art and necessary.

If I remember the original survey cited at the top of this thread correctly, a very high percentage of the individuals who had tried Beta Blockers did not have their own prescriptions. My concerns are that individuals may be using these drugs without appropriate medical supervision and sharing prescriptions.

My secondary concern is this. 30-, 40- and 50-year olds have a different level of sophistication with the medical treatment system than do 12-, 15-, and 17-year olds. Should minors be reading these posts and if they (or their parents or their clarinet teachers) feel that that there is a reason to consult a physician, they should be fully encouraged to do that (subject to any parental consent issues in the states in which they reside). Anyone should be discouraged from using prescription drugs that are not obtained through prescription. And I think that we do need to remind minors repeatedly that self (or peer or trusted non-professional adult) diagnoses and treatment are not desirable.

If you believe there is too much detail about who is and is not licensed in my original post, it was intentional because I think a lot of readers are younger and may not know this.

I believe that you and I do not differ in our positions about the appropriate use of these medications. I fully support their use, UNDER MEDICAL SUPERVISION, for individuals diagnosed by a competent professional. My point is primarily to ensure that everyone remembers to see a doctor and not self diagnose or let their friends or teachers "talk them into a problem."

And, should you wonder, I also strongly believe in second opinions from doctors and other professionals if the original diagnostician does not offer a full range of treatment options.

"...or let their friends or teachers "talk them into a problem."
-----------------------------------------------------------------------------

I couldn't let this pass while quickly glancing at the thread one last time.

To imply that in our writings, I or anyone else have stood logic on it's head and suggested in essence that those that advise our students are presenting a **solution in search of a problem** rather than a **problem in search of a solution** is unfortunate and patently absurd.

The sub-title of the article linked to at the top of this thread and the assumptions made based on it - namely that BBlockers are a "Dirty Little Secret" exposes the actual dirty little secret for what it really is....... the continued stigmatisation of those that take BBlockers by those who do not understand the subject matter about which they write or talk.

Sorry, I have triggered your last response. I agree with you 99% and do not question the use of BB for those who need it. My last post, may not reflect it appropriately. I am aware that it allowed many to overcome stage fright which could not have been controlled otherwise and saved many careers. I also want to make clear, that as long as there is no official competition, the subject of using drugs or not is meaningless. One should strive to put oneself in the best state possible to achieve their best.

On the other hand, I am also suggesting, not claiming, that not everybody is a well intentioned individual and that to a certain extent, musicians may have used BB in the hope of enhancing their performance. Whether or not BB enhance performance is to be proven. I was convinced it didn't, but read a single study suggesting otherwise.

If two normal (not affected by stage fright) individuals compete, one takes BB and the other doesn't.
Scenario #1: Assume BB don't increase performance. Who cares what if they take them! May the best man win.
Scenario #2: Assume BB do increase performance. Then, the BB user does have an unfair advantage.

My only disagreement with you, Greg and others is that Scenario #2 may be possible. I simply don't know, but I will leave that door open until given hard evidence that we are always in Scenario #1.

In the end, this is very much an exercise in futility, and I admit to have gotten in some way more interested in the debate than the topic. I am not suggesting drug screening at auditions and competitions and strongly believe that the pressure of performing live classical music is way above normal stress level and that one should do what he can to alleviate some of that pressure. I wish classical music performance was a wonderful, relaxed, and sharing experience for all, but our culture of achieving the best we can, always, will not change (at least not overnight).

This is my last post. Thanks for the discussions, I certainly learned a lot.

<If two normal (not affected by stage fright) individuals compete, one takes BB and the other doesn't.
Scenario #1: Assume BB don't increase performance. Who cares what if they take them! May the best man win.
Scenario #2: Assume BB do increase performance. Then, the BB user does have an unfair advantage.

My only disagreement with you, Greg and others is that Scenario #2 may be possible. >

Indeed no study has been made of this possiblity, rarely do they test drugs on people who lack any medical condition requiring treatment. My own experience is that when I took a beta block to check strength or effect without performing they had a mild dulling effect. For one who did not suffer disabling stage fright, but who either enjoyed performing (as one son does) or is able to concentrate through to having no nerves, it would more likely lessen one's ability. I believe Mark C. also noted this muffling effect. It is much better than the shaking, muddle headed misery that performance can be for those with this problem.

Well, I know of a great many players of all instruments who use Beta Blockers who happen to have blood pressure elevation for which they are prescribed. Whether the bbs helped their playing or not is perhaps superficial as elevated blod pressure can lead to no playing at all.
In my own case, I used to not be able to forecast what my fingers would do for the first 30 seconds of a performance and the bbs completely smoothed that out.
Once I had a great cup of hot coffee (from a machine) which I thought enhanced my playing, but who knows? As age practices its inexorable march on our parts, it is my thought that perhaps anything one uses in order to have control is fully justified.
When that performance is no longer in control due perhaps to the use of banned substances, we simply think we play better, but we don't really know, do we?
I used to have a half glass of wine prior to a performance until I went to Aspen and walked out on stage drunk, (it was like "holding on" for the whole performance)....because I failed to understand what altitude does to alcohol at over a mile high.

I get nervous as a cat before a performance and have not tried beta blockers because of the side-effect of possible asthma. Having been hauled into the local ER for asthma attacks, I'm not willing to try them.

Does anyone know how long BB's have been in existence? It's interesting to think of musicians who were successful prior to the introduction of such medications. How did they conquer their performance anxiety, assuming it was present? This has been a really fascinating topic.
Sue Tansey

Once again, some medical input from me, physician and clarinetist. Beta blockers came into use in the 1970's, one of those great triumphs of science and physiology to pharmacology. It was a dramatic breakthrough in management of heart disease and hypertension, and they remain the cornerstone of management to this day. Probably a musician scientist or physician discovered it's usefulness in controlling performance anxiety.

I would hope we can put to rest a few who continue to think beta blockers are performance enhancing. They effect is only to blunt the physiologic response of performance anxiety, that is of the "fight or flight" response of the adrenal glands releasing epinephrine and related hormones, more accurately interacting at the beta receptors of target organs such as the heart, blood vessels, muscles, skin, etc. There is no way that this effect enhances your playing ability, athletic performance, speaking in front of a group, etc.

By the way, one trick of the trade I have found useful. I have found that soaking my reeds in a 3.75 to 1.0 mixture of liquified alpazolam (Xanax) and suspension of morphine gives a wonderful mellow state, with lack of worry about upcoming tongued 16ths, and blissful ignorance of the conductor and audience. This is really enhanced by inhaling nitrous oxide immediately beforehand. Better living and playing through chemistry!